Abstract

In lieu of an abstract, here is a brief excerpt of the content:Microaggressions in Medicine:Narratives, Trauma, and SilenceElizabeth Lanphier (bio)Lauren Freeman and Heather Stewart (2024) have written a richly researched and argued, while also highly engaging and accessible, book with Microaggressions in Medicine. They argue for why microaggressions are best understood on a harm-based account and situate this view within timely examples from a range of healthcare experiences. In their view, focusing on the harms produced by microaggressions shifts the locus of concern from the agent committing a microaggression to the agent receiving it, and it enables an attribution of a microaggression regardless of an agent's intent or even awareness.Freeman and Stewart leave the reader with an expanded understanding of what microaggressions are and how they function. They also offer concrete and actionable suggestions for how healthcare environments and healthcare providers can work to prevent patients from receiving microaggressions in clinical care. Thinking alongside this book, I raise three points intended to further a conversation. The first is about narrative medicine as an additional resource. The second is the possibility for trauma-informed care to address background structural conditions that were beyond the book's scope. The third is to briefly inquire about whether this harm-based account could characterize certain cases of individual and institutional silence as a microaggression.1. Narrative medicineFreeman and Stewart situate their book within the philosophical literature on epistemic injustice, social justice, and feminist theory. So, it is not necessarily surprising that they only mention "narrative medicine," a term coined by Rita Charon (2001) about twenty-five years ago, in passing. They do cite core narrative medicine literature, including Sayantani DasGupta's (2008) account of "narrative humility," Arthur Frank's (1995) book The Wounded Storyteller, and a paper on listening to patient stories (Goldie 2011) in their recommendations and resources for mitigating microaggressions. When they do reference narrative [End Page 163] medicine, it is to suggest that "attending to the identities of patients ought to be more widely recognized as constitutive of good care" (Freeman and Stewart 2024, 182). But beyond illustrating the caring capacities of compassionate and skilled clinicians, narrative medicine offers a potential roadmap for how to get there.What I have elsewhere called a "technical definition of narrative medicine" (Lanphier 2021, 2024) is the narrative medicine methodology of close reading and reflective writing intended to produce three aims: attention (to texts or story), representation (trying to see the perspective of a story), and affiliation (partnering with a story's teller in a solidaristic way). This technical understanding of narrative medicine provides a method for developing skills of "ethical listening" and "medical humility" that Freeman and Stewart recommend. It also affords a structured form of training and practice that institutions can support to better enable healthcare workers to implement individual and environmental correctives to address microaggressions.Although narrative medicine is a resource poised to counter and respond to the very kinds of failures of listening, epistemic injustices, and quick assumptions with which Freeman and Stewart are concerned, narrative practices are not necessarily a fix for epistemic failures or bias. They also run their own risks, including narrative presumptions (Lanphier and Anani 2019), or narrative neglect (Saulnier 2020). Moreover, while the potential exists to scale narrative medicine through structured learning opportunities and broader institutional support, it primarily remains a tool for individual edification and enactment, not systems change.2. Trauma-informed careFreeman and Stewart (2024) describe how "microaggressions occur at the individual level and can be perpetrated by individuals, environments, or institutions" but that "ultimately, they are manifestations or symptoms of structural-level problems. Regardless of the level on which they occur, microaggressions always happen against the backdrop of social and structural oppression" (12). As other commentators point out, the authors recommend correctives primarily at individual and environmental levels (i.e., changing individual behaviors, making small modifications to clinical environments). Freeman and Stewart understand the limits of this scope, saying, "[W]e are well aware that such individual-level fixes can only ever take us so far and that they alone will never dismantle the oppressive structures themselves" (13). It is reasonable to identify achievable individual actions for the "unjust meantime" (Jaggar 2019) concurrent with social and structural...